Tracking a Hospital Outbreak of Carbapenem-Resistant Klebsiella Pneumoniae With Whole-Genome Sequencing

Sci Transl Med. 2012 Aug 22;4(148):148ra116. doi: 10.1126/scitranslmed.3004129.

Abstract

The Gram-negative bacteria Klebsiella pneumoniae is a major cause of nosocomial infections, primarily among immunocompromised patients. The emergence of strains resistant to carbapenems has left few treatment options, making infection containment critical. In 2011, the U.S. National Institutes of Health Clinical Center experienced an outbreak of carbapenem-resistant K. pneumoniae that affected 18 patients, 11 of whom died. Whole-genome sequencing was performed on K. pneumoniae isolates to gain insight into why the outbreak progressed despite early implementation of infection control procedures. Integrated genomic and epidemiological analysis traced the outbreak to three independent transmissions from a single patient who was discharged 3 weeks before the next case became clinically apparent. Additional genomic comparisons provided evidence for unexpected transmission routes, with subsequent mining of epidemiological data pointing to possible explanations for these transmissions. Our analysis demonstrates that integration of genomic and epidemiological data can yield actionable insights and facilitate the control of nosocomial transmission.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carbapenems / pharmacology*
  • Colistin / pharmacology
  • Contact Tracing
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Cross Infection / transmission
  • Disease Outbreaks / statistics & numerical data*
  • Drug Resistance, Bacterial / drug effects
  • Drug Resistance, Bacterial / genetics*
  • Female
  • Genome, Bacterial / genetics*
  • Hospitals / statistics & numerical data
  • Humans
  • Klebsiella Infections / epidemiology
  • Klebsiella Infections / microbiology
  • Klebsiella Infections / transmission
  • Klebsiella pneumoniae / drug effects
  • Klebsiella pneumoniae / genetics*
  • Klebsiella pneumoniae / isolation & purification
  • Male
  • Middle Aged
  • Molecular Sequence Data
  • Mutation / genetics
  • Polymorphism, Single Nucleotide / genetics
  • Sequence Analysis, DNA / methods*
  • United States / epidemiology
  • Young Adult

Substances

  • Carbapenems
  • Colistin

Associated data

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